classifications of aphasia expressive vs. receptive …€¦ · what is aphasia tips for...
Post on 03-Feb-2021
9 Views
Preview:
TRANSCRIPT
-
12/7/2018
1
APHASIA
Aphasia is an acquired communication disorder that impairs a person’s ability to process LANGUAGE, but DOES NOT AFFECT intelligence. Aphasia impairs the ability to speak and understand others.
-National Aphasia Association
LANGUAGELanguage is a system of communication that uses symbolism. K L U $ + M –Phonemes: perceptually distinct unit of soundsWords: sounds combined & given meaningSentences: combination of syntax (rules) and semantics (meaning).
• CLASSIFICATIONS OF APHASIAEXPRESSIVE VS. RECEPTIVEFLUENT VS. NON-FLUENT
-
12/7/2018
2
-NATIONAL APHASIA ASSOCIATION
-COURTESY OF MY-MS.ORG
MCA DISTRIBUTION -SLIDESHARE.NET
-
12/7/2018
3
BROCA’S APHASIA* short utterances* limited vocabulary* halting, effortful speech*mild comprehension deficits
Lesion* Inferior frontal gyrus
IdeaChoose Words
(Semantics)
Sentence Structure (Syntax)
Speech Sounds
(Phonology)Coordinate
Muscles ArticulateSpeak
Fluently Pragmatics
SAMPLE OF BROCA’S THERAPY FROM TACTUS THERAPY
-
12/7/2018
4
WERNICKE’S APHASIA• Comprehension is poor (auditory &
reading)• Fluent, intact prosody• Logorrhea, press of speech• Neologisms, Paraphasias• Lack of awareness
LesionTemporo-Parietal, Posterior section of the superior temporalgyrus near the auditory cortex
Input Perception RecognitionAuditory
PhonologicalAnalysis
AttachMeaning
PreparationFor
Output
WERNICKE’S APHASIA FROM TACTUS THERAPY
-
12/7/2018
5
GLOBAL APHASIA* severe language deficit* responds to personally relevant language
* responds to non-verbal cues* some automatic speech
LesionBroca’s & Wernicke’s AreaPerisylvian region
WHAT DID THEY SAY?ANOMIA (Without Name)Tip of tongue, unable generate labelCommon with Many AphasiasAnomic Aphasia
PERSEVERATIONOverstimulation of the wrong targetthat occurred before question oractivityStereotypy
PARAPHASIAS * Language errors characterized by unintended syllables, words during speaking attemptsPhonemic/Literal-substitution of sound(s) for another,i.e., “thistle” for “whistle”
Verbal-substitution of real word for target word, i.e., cat/dog…chair/dog
* Agrammatism-difficulty with formulating grammatically correctsentences, telegraphic speech
-
12/7/2018
6
OTHER CONSIDERATIONS*APRAXIA (DIFFICULTY PLANNING AND EXECUTING VOLUNTARY MOVEMENTS) -WORDPRESS.COM
VERBAL* SOUND SUBSTITUTIONS, GROPING
FOR ARTICULATORY PLACEMENT* VOICE ONSETNON-VERBAL* DIFFICULTY WITH ORAL
COMMANDS, I.E. SMILE, STICKOUT YOUR TONGUE
* NODDING/SHAKING HEADFOR YES/NO INDICATION
CONSIDER MELODIC INTONATION
LIMB* DIFFICULTY EXECUTING BODY
MOVEMENTS FOR COMMANDS THAT WERE COMPREHENDED
* POINTING (COMMUNICATIONBOARDS)
* LESS SO WITH GROSS MOTOR, I.E.LEGS
IDEATIONAL* PLANNING ISSUES RELATED TO
USE OF OBJECTS
-
12/7/2018
7
HOLLAND AND FRIDIKSSON, 2001. INDICATING FORMAL TESTING AND IMPAIRMENT BASED APHASIA TX, MAY NOT BE APPROPRIATE IN THE ACUTE CARE PHASE OF STROKE.APHASIA MANAGEMENT DURING THE EARLY PHASES OF RECOVERY FOLLOWING STROKE
WHY? *SHORTENED HOSPITAL
STAY*FEAR, ANXIETY, FRUSTRATION*MAY NOT BE READY TO
RECEIVE OR BENEFIT FROM REMEDIATION/INSTRUCTION
* SPONTANEOUS RECOVERYWEBSTER, NEWHOFF (1981)
* POSTPONE FORMAL TESTING FOR A FEW DAYS
* CAN MIX FORMAL TESTING WITH INFORMAL INTERACTIONS.DOCUMENT STRENGTHS ANDWEAKNESSES
* EDUCATION/COUNSELING
-
12/7/2018
8
EDUCATION/COUNSELING* STAFFSHARE “TEST” RESULTS, STRENGTHS WITH NURSING
* FAMILY/PATIENTWHAT IS APHASIATIPS FOR COMMUNICATIONDIAGRAMSSPONTANEOUS RECOVERY
INFORMAL ASSESSMENT* ESTABLISH MEANS OF YES/NO* USE ITEMS IN ROOM TO MAKE
CHOICES, PROBE AUDITORY DISCRIMINATION, COMMANDS
* USE GREETING CARDS, MENUFOR READING
* WRITE FAMILIAR FAMILY NAMES* PROBE NAMING WITH ITEMS IN ROOM,
FAMILY PICTURES
15 MINUTE SEGMENTS (FATIGUE)
BOSTON DIAGNOSTIC APHASIA EXAMINATION (BDAE)-NORMED TEST-%TILE RANKS-USED FOR NIH STROKE SCALE, COMMON “LANGUAGE” WITH NURSING –GOODGLASS & KAPLAN
-
12/7/2018
9
A WORD ABOUT YES/NO* BIOGRAPHICAL INFORMATION* 50% RULE* EYE BLINKS, EYE GAZE, NOD/
SHAKE, THUMBS UP/DOWN* VERTICAL VS. HORIZONTAL* ASK “NO” RESPONSE ?’S* POINTING, FACILITATE ARM MOTION,
PLACE PENCIL/PEN IN HAND* ASK NURSING, FAMILY WHAT WORKS* POST WHAT WORKS, ALL DOING
THE SAME THING
MAY BE LOW TECH, BUT…COLOR CUESYMBOL CUEEXPRESSION CUE
EXPLORE FREE APPSLET ME TALK YES/NOAPPNOTICE UG UTOPIA PROGRAMMING, LLC
-
12/7/2018
10
TEXTING, USE OF WORD PREDICTION
AUGMENTATIVE COMMUNICATION BOARDS -VIDATAK, CHILDREN’S HOSPITAL BOSTON
-
12/7/2018
11
-
12/7/2018
12
ORIENTATION
EDUCATION“INFORMATION ABOUT APHASIA, STROKE, AVAILABLE RESOURCES”, WORRALL, ET AL 2011
LOW TECH
-
12/7/2018
13
SPONTANEOUS RECOVERY* EARLY IMPROVEMENT MAY REFLECT
RETURN TO FUNCTION OF COMPROMISED BRAIN AREAS
* TURKELTAUB ET AL. (2001) EVIDENCEOF LANGUAGE REORGANIZATION TO HOMOTOPIC REGION IN RIGHT HEMISPHERE
* ROBSON ET AL. (2014) RECRUITMENT OF THE ANTERIOR TEMPORAL LOBES FOR COMPREHENSION IN WERNICKE’SAPHASICS
TIPS FOR COMMUNICATING WITH PWA
* EYE CONTACT (EDUCATE RE: NEGLECT)* USE SHORTER SENTENCES* DON’T TALK DOWN* LIMIT NOISE, DISTRACTION* GIVE CHOICES* ASK YES/NO QUESTIONS* OFFER GESTURE, DRAWING, WRITINGASHA.ORG (AMERICAN SPEECH, HEARING ASSOCIATION)NATIONAL APHASIA ASSOCIATIONAMERICAN STROKE ASSOCIATION
OTHER RESOURCESFree or Low Cost AppsStroke Support GroupsMissouri State University Speech-Language Hearing Clinic
-
12/7/2018
14
PRICE VARIES $5 - $25EVIDENCE BASED FREE LITE VERSIONS FREE
Tactus Therapy Lingraphica’s Talk Path
CONSTANT THERAPYTabletSmart phone$25 monthly$250 yearly- The Language Corp.
-AMERICAN SPEECH HEARING ASSOCIATION
-
12/7/2018
15
INTELLIGENCE: ONE’S CAPACITY FOR LOGIC, PROBLEM SOLVING, CREATIVITY, PLANNING, SELF AWARENESS, LEARNING….
UNRAVELING NONVERBAL COGNITIVE PERFORMANCE IN ACQUIRED APHASIA ROBERT FUCETOLA, ET AL 2009
“IMPAIRMENT IN NON-VERBAL COGNITIVEABILITY IS NOT FULLY EXPLAINED BY LANGUAGECOMPETENCE IN PERSONS WITH APHASIA”
ATTENTION AND OTHER COGNITIVE DEFICITS IN APHASIA: PRESENCE & RELATIONSHIP TO LANGUAGE & COMMON MEASURES, LAURA MURRAY, 2012
“GROUP WITH APHASIA PERFORMED SIGNIFICANTLY MORE POORLY ONCOGNITIVE MEASURES, BUT DISPLAYEDVARIABILITY IN PRESENCE, TYPES, SEVERITY OF THEIR ATTENTION & OTHER DEFICITS”,
SYMBOL CANCELLATION (COGNITIVE LINGUISTIC QUICK TEST) HELM-ESTABROOKS, 2011
-
12/7/2018
16
TRAILS-CLQT, HELMS-ESTABROOKS, 2011
DIVIDED ATTENTION
EXECUTIVE FUNCTIONSRange of Cognitive Abilities including goal formulation, planning, carrying out goal directed plans, and monitoring effects of actions (quality control)
THE RELATION BETWEEN LANGUAGE, NON-VERBAL COGNITION AND QUALITY OF LIFE IN PEOPLE WITH APHASIA ( NICHOLS, ET AL 2017)
• 28 PWA, Chronic phase• Language battery, non-verbal
cognitive battery, quality of life battery (aphasia friendly)
• NVC impairment predicted 3x the variance on a measure of QOL than Language impairment
• Emerged predictors: Trails task, Visual Memory task & Maze
-
12/7/2018
17
C-SPEAK APHASIASTUDY(NICHOLAS, SINOTTE & HELM-ESTABROOKS, 2011)
C-SPEAK APHASIA STUDY(NICHOLAS, ET AL 2011)• 10 PWA, chronic aphasia• Severe, non-fluent aphasia• 6 months training using C-Speak• Carry-over to functional communication
(making phone calls, answering biographical questions, describing person-action pictures, describing a short video, writing a card and grocery list)
• 4 out of 10 communicated more information with computer than without
• Baseline non-linguistic executive function skills, pictorial semantic knowledge and auditory comprehension
• Only non-linguistic executive function skills correlated with treatment response
WAIS R: WECHSLER ADULT INTELLIGENCE SCALE (THE PSYCHOLOGICAL CORPORATION) AND PYRAMID AND PALM TREES TEST (HOWARD & PATTERSON)
-
12/7/2018
18
RAVEN’S PROGRESSIVE MATRICES -JOHN RAVEN 1936
WISCONSIN CARD SORT-DAVID GRANT, ESTA BERG
TIC TAC MAZESCLQT, NANCY-HELM ESTABROOKS, 2011
PROMOTE COMMUNICATIONFor Our Severe Clients - Supported Communication
- Melodic Intonation- Visual Action Therapy- Scripting; Aphasia- Personalized Vocabularies- Multi-modality communication
(Famous People Protocol)- Technology!!
-
12/7/2018
19
NON-PROPOSITIONAL LANGUAGEOVER-LEARNED, ROTE* COUNTING, DAYS OF WEEK* PRAYERS* WELL KNOWN SONGS* CURSING
LIMBIC SYSTEM, BASAL GANGLIA,RIGHT HEMISPHERE STRUCTURES
-EXPLETIVES: NEUROLINGUISTIC AND NEUROBEHAVIORAL PERSPECTIVES ON SWEARING, VAN LANKKER, CUMMINGS, OCTOBER 1999.
MELODIC INTONATION (MIT)Uses musical elements of speech (melody, rhythm, stress) to improve language (apraxia)Intoning simple 2-3 syllable phrases – 5+ syllable phrases3 levels (elementary, intermediate, advanced)
MELODIC INTONATION CONT.
Uses 2 pitches. Stressed syllables have upward pitch, unaccented syllables have downward pitchLeft hand taps each syllable (paces speaker and may involve right hemispheric sensorimotor network)Elementary level: Humming, Unison Intoning, Unison Intoning with Fading, Repetition, Response to a probe question
-
12/7/2018
20
PERSONALIZED VOCABULARY“YOU WANT TO GO FOR A WALK?” “GO, JOHN, GO!”
SHIRLEY RYAN ABILITY LAB-FORMERLY RICPERSONAL ANIMATED THERAPIST (PAT), 20 SCRIPTS, EDITOR OPTION TO CREATE OWN SCRIPTS, REPEATED PRACTICE, REQUIRES WINDOWS
FAMOUS PERSON PROTOCOL
*APHASIA BANK*PROMOTES MULTI-MODALITY COMMUNICATION
-
12/7/2018
21
WORD FINDING TREATMENT• Common to have Confrontation
Naming Goals• Boston Naming Test• Spreading Activation from M. R.
Quilllan’s (1967) theory of semantic memory search
• The search process is initiated by labeling a set of source nodes (concepts in a semantic network) with “weights” of activation then spreading that activation to other nodes linked to the source
SPREADING ACTIVATION THEORY
SEMANTIC FEATURE ANALYSIS
1) PATIENT TO NAME PICTURE
2) ASKED TO GENERATE FEATURES
3) PATIENT TO NAME PICTURE AGAIN
ACTIVATION OF SHARED FEATURES RESULTS IN SPREADING ACTIVATION TO OTHER CATEGORY MEMBERS
-
12/7/2018
22
SEMANTIC FEATURE ANALYSIS: TRAINING ATYPICAL EXEMPLARS
“Training atypical items within a category and their semantic features results in generalization to naming of intermediate and typical exemplars of the category selected for training.” –Kiran & Thompson, 2003
TRAIN ATYPICAL EXEMPLARS TO PROMOTE GENERALIZATION (SFA) (KIRAN & THOMPSON, 2003)
VNEST PROTOCOL: VERB NETWORK STRENGTHENING PROGRAM, EDMONDS, 2014• Takes SFA a step further,
focusing primarily on verbs• Focuses on Agrammatism
(strengthens sentence structure, S+V+O)
• Same verb, but promotes semantic variety
• Pictures not used, promoting mental flexibility
-
12/7/2018
23
10 VERBS (TRANSITIVE, AVOID OVERLAP)
3-5 HRS. A WEEK/10 WEEKS
3 X 5 CARDS
3 PAIRS SUBJECTS/OBJECT“WHO”, “WHAT”
CLIENT READS EACH TRIAD
CHOOSE ONE TRIAD
EXPAND TO “WHERE”, “WHY”, “WHEN”
CLIENT READS ALOUD
CLEAR TABLE, ASK 12 QUESTIONS ABOUT VERB, CLIENT DECIDES CORRECT/INCORRECT
RECALL VERB
REPEAT FIRST STEP WITHOUT CUES
VNEST PROTOCOL -EDMONDS, 2014
-
12/7/2018
24
WHEN IT COMES TO MEDICATIONS• Reduce Polypharmacy• Avoid topiramate (can worsen
anomia) –Mula, 2012• Many single case studies that would
indicate benefit for Aphasia• Address neurotransmitter systems disrupted
by stroke• Medication enhancing plasticity• Cholinesterase Inhibitors
A RANDOMIZED PLACEBO-CONTROLLED STUDY OF DONEPEZIL IN POST STROKE APHASIA• Berthier, et al 2006• 26 participants, 70 y/o or younger, chronic aphasia (1yr. or greater) • Computer randomized, well matched baseline variables• Western Aphasia Battery (WAB), Communication Activity Log (CAL),
Psycholinguistic Assessments of Language Processing in Aphasia (PALPA)
• 5mg/daily or placebo during a 4 week titration followed by 12 weekmaintenance (10mg/daily), followed by 4 week wash out phase
• Testing at 0, 4, 16 (endpoint), 20 (washout) week(s)• Concurrent Speech Language Therapy, 2 hrs. per week
“Syndrome specific standard approach”
RESULTS:• Statistically significant changes in
Aphasia Quotient (AQ) on the WABIncreased picture Naming on the (PALPA)
• Between group differences no longer significant at week 20. Suggests continued usage needed for benefit
• Adverse events higher for Donepezil group than placebo (Irritability (4), Insomnia (2) only during titration. 2 with recurrence of post stroke seizure without relapse after dose adjustment
-
12/7/2018
25
GALANTAMINE ADMINISTRATION IN CHRONIC POST-STROKE APHASIA,HONG, 2012• 45 patients, 75 y/o or less, 1 year or
greater post stroke• Week 0 – Week 16• 8 mg/day for 4 weeks, 16 mg/day for
following 12 weeks• Spontaneous speech, comprehension,
repetition, naming• AQ on WAB
RESULTS• Statistically significant increase in total
AQ WAB score in Galantamine group• In Galantamine group, “good” vs.
“poor” responders. “Good” responders had higher level education, higher baseline Mini-Mental Status Exams
• Beneficial effect more prominent in subcortical dominant lesions
AUDITORY TRAINING CHANGES TEMPORAL LOBE CONNECTIVITY IN WERNICKE’S APHASIA: A RANDOMIZED TRIAL – WOODHEAD ET AL. (2017)• 20 patients, 2 concurrent treatments• 5 week blocks• Drug only (5 mg. Donepezil)• Drug (10 mg.) + Earobics (two 40 min Tx)• Placebo• Placebo + Earobics
-
12/7/2018
26
RESULTS: • Statistically significant (but small) improvement
in speech comprehension with Phonological training (Earobics)
• Improvements including Generalization,improved written comprehension
• Worse comprehension with medication than placebo
• Both effects stronger in more severely impaired patients
• Take away: Donepezil may be better suited for speech expression vs. comprehension
REFERENCES IN ORDER OF OCCURRENCE Holland, A., and Fridiksson. (2001). Aphasia Management During Early Phases of Recovery Following Stroke. American Journal of Speech-Language Pathology, 10 (1): 19-28. Webster, E. & Newhoff, M. (1981). Intervention with families of communicatively impaired adults. In D.S. Beasley & G.A. Davis (Eds). Aging: Communication processes and disorders. Orlando, Fl : Grune & StrattonWorrall, L., Sherratt, S., Rogers, P., Howe, T., Hersh, D., Ferguson, A. (2010). What people with aphasia want: Their goals according to the ICF. Journal of Aphasiology, pages 309-322Turkeltaub, P.E., Messing, S., Norise, C., & Hamilton, R.H. (2011). Are networks for residual language function and recovery consistent across aphasic patients? Neurology, 76, 1726-1734.Robson, H., Zahn, R., Keidel, J.L., Binney, R. J., Sage, K., & Ralph, M.L. (2014). The anterior temporal lobes support comprehension in Wernicke’s aphasia. Brain, 137, 931-943.Robert Fucetola, Lisa T. Connor, Michael J. Strube & Maurizio Corbetta (2009.)Unraveling nonverbal cognitive performance in acquired aphasia, Aphasiology, 23:12, 1418 – 1426Murray, L. (2012). Attention and Other Cognitive Deficits in Aphasia: Presence and Relation to Language and Communication Measures. American Journal of Speech-Language Pathology. Vol 21, 51-64.
REFERENCES CONTINUED:Nicholas, M., Hunsaker, E., & A.J. Guarino. The relation between language, non-verbal cognition and quality of life in people with aphasia (2015)Journal of Aphasiology Volume 3, 688-702Nicholas, M., Sinote, Michelle P., Helm-Estabrooks, N. (2011) C-Speak Aphasia alternate communication program for people with severe aphasia: Importance of executive functioning and semantic knowledge, Neuropsychological Rehabilitation, 21:3, 322-366.Van Lancker, D., Cummings, J.L. Expletives: Neurolinguistic and neurobehavioral perspectives on swearing. (1999). Brain Research Reviews (1): 83-104Kiran, S. & Thompson, C. The Role of Semantic Complexity in Treatment of Naming Deficits: Training Semantic Categories in Fluent Aphasia by Controlling Exemplar Typicality (2003)Journal of Speech, Language and Hearing Research. Volume 46, 608-622Edmonds, L.A. (2014). Tutorial of Verb Network Strengthening Treatment (VNEST): Detailed description of the treatment protocol with corresponding theoretical rationale. SIG 2 Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 24(3), 78-88
-
12/7/2018
27
REFERENCES CONTINUED
Mula, M. Topitamate and cognitive impairment: evidence and clinical implications. (2012)Therapeutic Advances in Drug Safety. Dec 3(6):279-289
Berthier, M., Green, C., Higueras, C., Martin, M.C.,(2006) A randomized, placebo-controlled study of donepezil aphasia. Neurology 67(9):1687-9
Hong, J., Lee, J., Lim, T., Shin, D. Galantamine administration in chronic post-stroke aphasia (2012)Journal of Neurology. 83(7):675-80
Woodhead, Crinion, Teki (2017)Auditory training changes temporal lobe connectivity in Wernicke’s aphasia: a randomized trial. Journal of Neurology/Neurosurgery Psychiatry
THANK YOU
top related