1. What are the Right-Hemisphere Dysfunctions, Traumatics Brain Injury, And Dementia?
1.1. Right Hemisphere Dysfunction
1.1.1. definition: results from neurological damage to the right cerebral hemisphere. commonly reffered to as cognitive-linguistic disorder
1.1.2. Right hemishpere is responsible for many non language functions, including comprehension of visual-spatial information and emotional expression
1.1.3. Characteristics of RHD
1.1.3.1. 1. Lack of awareness of cognitive-linguistic deficits and possible denial of problem areas
1.1.3.2. 2. Lack of awareness, or complete neglect, of the left side of the body and external stimuli to the left side, including physical limitations, such as paralysis of the left leg or arm, and visual-spatial neglect, in which the individual does not process information in the left visual field and which can negatively impact reading and writing
1.1.3.3. 3.Difficulty recognizing faces
1.1.3.4. 4.Compromised pragmatics, such as ability to read other peoples cues, recognize others communication interest, and use of physical space and affect appriately during communication
1.1.3.5. 5. A tendency toward using wordy expressions and providing tangential information
1.1.3.6. 6. Difficulity understanding or using higher level cognitive-linguistic skills, such as problem solving or abstract thought
1.1.3.7. 7. Dysarthia or dysphagia when neuromuscular systems are compromised
1.1.4. Identification of RHD
1.1.4.1. When RHD is suspected, testing must assess higher level language skills including predicting, reasoning, understanding humor and figurative language, and problem solving.
1.1.4.2. Visual-perceptual performance and pragmatic appropiateness
1.1.4.3. benefit from comprehensive neuropsychological testing
1.1.4.4. Mini Inventory of Right Brain Injury (MIRBI)
1.1.4.5. Clinical Management of Right Side of the Right Hemisphere (
1.1.5. Treatment of RHD
1.1.5.1. Initial therapy for RHD targets the management of attention and visual disruptions
1.2. Traumatic Brain Injury
1.2.1. definition: neurological damage to the brain resulting from the impact of external forces
1.2.2. Occurs as a result of motor vechile accidents, falls, or acts of violence.
1.2.3. Leading cause of death and disability in the United States
1.2.3.1. Males are twice as likely to experience TBI as females
1.2.3.2. more likely in infants,adolesecents, and senior citizens over 65 years of age
1.2.4. Characteristics of TBI
1.2.4.1. Open-head Injuries occur when the skull and the meninges have been penetrated
1.2.4.1.1. stem from violent acts using guns, ice picks, and other sharp instruments.
1.2.4.1.2. Phineas Gage
1.2.4.2. Closed-head Injuries typlically result from motor vechike accidents, falls, sports injuries, physical assult, or abuse such as shaken baby syndrome
1.2.4.3. Polytrauma refers to the mixture of open- and closed- head injuries, multiple medical concerns
1.2.4.4. affects the psychological realm as well: emotions, temperament,motivation,and self-awareness
1.2.5. Inentifiaction of TBI
1.2.5.1. Glascow Coma Scale
1.2.5.1.1. cognition, language, communication, psychosocial functions
1.3. Dementia
1.3.1. chronic and progressive decline in memory, cognition, language, and personality resulting from central nervous system dysfunction
1.3.1.1. Alzhemier's
1.3.1.2. Hungintington's
1.3.1.3. Parkinsions
1.3.1.4. Creutzfeldt-Jakob
1.3.1.5. AIDS
2. What is Aphasia?
2.1. definition: a language disorder that is aquired sometime after an individual has develpoed language competence
2.1.1. "the absence of learning" or "without language"
2.1.2. a disturbance of one or more aspects of the complex process of comprehending and formulating verbal messages the results from newly aquired diseases of the central nervous system (A. Damasio, 1981, p.51)
2.1.3. 1. aphasia is a disturbance in the language system after language has been established or learned 2. aphasia results from neurological injury in the language-dominant hemisphere of the brain 3. aphasia includes disturbances of receptive or expressive abilities for spoken and written language
2.1.3.1. affects are influenced by: health, emotional well-being, occupational and educational attainment, and language abilities
2.2. results from injury to the language functions of the brain.(commonly the left hemisphere)
2.3. strokes is the neurological disorder that produces the most aphasias
2.3.1. also called a cerebrovascular accident (CVA)
2.3.2. Types of strokes:
2.3.2.1. Ischemic Stroke: blood supply to the brain is inhibited because of a blockage somewhere in the artery. Can occur because of thromosis or embolism
2.3.2.1.1. Thrombosis: occurs when plaque builds up in the artery and eventually closes it off, prohibiting the flow of blood
2.3.2.1.2. Embolism: occurs when accumulated plaque breaks off of an artery, migrates from larger arteries into smaller arteries where it ultimately will lodge, blocking the flow of blood
2.3.2.2. Hemorrhagic Stroke: blood vessel or artery ruptures and excessive amounts of blood enter the brain
2.4. aphasia is not limited to soely problems of spoken language; it also emcompasses disturbances in written skills ( reading, writing)
2.4.1. not a motor speech disorder: inability to plan, program, or excute the motor movements required for efficient, intelligible speech production as a result of neurological deficits
2.4.1.1. Dysarththria: motor speech disorder characterized by disruption in the range, speed, direction, timing, and strength of movements in the repiratory, phonatory, articulatory, or resonatory components of speech
2.4.1.1.1. coexist with aphasia
2.4.1.2. Apraxia: motor speech disturbance, difficulity in planning and excuting the volitional movements of speech
3. How Is Aphassia Classified
3.1. Behavioral symptoms:
3.1.1. Fluency: qualitative aspect of communication and speech that is used to describe its foward flow, including it phrasing, intonation, and rate
3.1.1.1. Fluent: easy, smooth, and well paced
3.1.1.1.1. Sensory aphasia- speech flows well with adequate phrase length, although often the content of the language is affected
3.1.1.1.2. correlated eith posterior brain damage ( temporal- pariental regions)
3.1.1.2. Nonfluent: Short, choppy phrases Slow, labored production of speech Grammatical errors Telegraphic quality
3.1.1.2.1. Correlates to injury anterior in the brain (frontal lobe)
3.1.2. Language Comprehension: (auditory comprehension)- the ability to understand spoken language
3.1.2.1. interpretation of what is heard
3.1.2.2. Aphasia characterized by comprehension problems is often reffered to as receptive aphasia
3.1.2.2.1. affects temporal lobe-language resides here
3.1.3. Repetition- ability to acurately reproduce verbal stimulion demand
3.1.3.1. an ability that is seriously compromised
3.1.4. Naming (word retrieval)- is the ability to retrieve and produce a targeted word during conversations or more structured task
3.1.4.1. Anomia- "no name" term used to describe word-finding problems or the inability to retrieve a word
3.1.4.1.1. one of the most persistent deficits in aphasia
3.1.4.2. phonemic paraphasia- occurs when there is a substitution or transportation of a sound
3.1.4.2.1. prevalent in nonfluent expressive aphasias
3.1.4.3. semantic paraphasia-word subsituted, often one that is in the same category as the targeted word
3.1.4.3.1. fluent and receptive classifications
4. What Are The Defining Characteristics Of Aphasia Syndromes
4.1. Broca's Aphasia: results from damage to the frontal lobe of the brain
4.1.1. Plans and orchestrates the intricate motor movements for speech
4.1.2. Produces a nonfluent, expressive, motor aphasia profile
4.1.3. Fluency and Motor Output: slowed, halting, labored speech, telegraphic or robotlike quality. -No more than four or five words in utterance. -Function words are ommitted (articles, prepostitions, and conjunctions) -Missing inaccurate tense markers (-ed,-ing)
4.1.4. Language Comprehension: Mild to moderate comprehension problems, particularly when messages increase in length an complexity or when contexual cues are removed May be able to follow simple directions
4.1.5. Repetition - Highly variable in their repitition abilities, ranging from mildly to severly impared
4.1.6. Naming- have mild to severe anomia, characterized by phonemic paraphasias
4.1.7. Reading and Writing- Imapct of the neurological injury on reading and writing parallels its impact on verbal performance. Reading is slow and laborious with misarticulations or distortions, writing is effortful. Misspellings are also common, with incorrect letter choices and letter transportation
4.1.7.1. Oversized printing- macrographia
4.2. Transcortical Motor Aphasia: results from damage to the frontal lobe, typically the superior and anterior portions.
4.2.1. Characterized as nonfluent, expressive, and motor in its typology
4.2.2. Have repetition skills that are far better than their spontaneous speech
4.2.3. Strong performance in oral reading
4.3. Global Aphasia: result as a large region of brain damage or multiple sites of brain injury in the language-dominant hemisphere
4.3.1. Deficits across all language modalities
4.3.2. Severe problems communicating, since they have difficulties recieving and sending messages
4.3.3. Nonverbal with limited gestures
4.4. Wernicke's Aphasia: resluts from brain injuries to the superior and posterior regions of the temporal lobe, possibly reaching to the pariental lobe of the language-dominant hemisphere
4.4.1. fluent, receptive, and sensory aphasia
4.4.2. Fluency and motor output- many talk excessively, use of made up words, and use of real words put together without any meaning
4.4.2.1. difficulity monitoring their own language production,
4.4.2.2. lack the insight that they are attempting to say
4.4.3. Language Comprehension- difficulity interpting verbal and written messages. Simple language can be difficult to comprehend
4.4.4. Repetition- difficulty with repetition. involves both comprehension and productionof that message
4.4.5. Naming- moderate to severe naming difficulties
4.4.5.1. circumlocution: talking around a word that cannot be reteieved
4.4.6. Reading and Writing- reading may be inact, comprehension of the text is likely to degraded to the level of comprehension of spoken communication
4.5. Conduction Aphasia- results from injury to the temporal-parietal region of the brain
4.5.1. Fluecy and motor output- fluent with only mild deficits in expessive output
4.5.2. Repetition- difficulties with repetition and reading aloud are th hallmark. Aware of their repetition reading errors and will attempt to revise and improve thier own production, possibly numerous times and with considerable frustration