Adult Language Impairments

Aphasia

● Definition:
o Aphasia is an acquired language disorder that is
caused due to a neurological incident of the
dominant language hemisphere. It affects the
components of language and excludes sensory,
motor, or intellect as contributing factors (Hallowell &
Chapey, 2008).
Types of Aphasia
● Fluent versus Non-fluent Aphasia:
o Fluent
o Characterized by: word substitutions, neologisms,
verbose verbal output
▪ https://youtu.be/3oef68YabD0
▪ May be some hesitations, but words generally
flow in manner that sounds relatively normal.
o Non-fluent (e.g. Sarah Scott video in Blog)
o Utterances characterized by effortful, hesitant
speech.
Aphasia
● Number of people in the US with aphasia:
estimates range from 1-2 million
● Aphasia affects individuals and families
o Initially, have to deal with the medical crisis
o Then, faced with lingering, often chronic deficits
o Aphasia changes the social role of the individual,
and the social roles of the people who love and care
for him/her
Causes of Aphasia
● Associated with acquired brain damage:
o Most frequently caused by stroke also called
cerebrovascular accident (CVA), or “brain attack”)
o Other causes could be a traumatic brain injury (TBI),
brain tumor, brain infection, brain surgery

● CVA or stroke:
o Fourth leading cause of death in US
o 100,000 new cases of aphasia due to stroke every year
in the US
o 75% of individuals with a stroke are above 65 years of
age.
Types of Stroke
1. Ischemic strokes
o Result from complete or partial blockage of arteries
transporting blood to brain
o Causes the brain to have a reduction in the amount of
oxygen supply
o Two types of ischemic strokes,
▪ Thrombosis: obstruction in blood flow, plaque/ blood
clot forms on site and does NOT travel
▪ Embolism: obstruction in blood flow, plaque/blood clot
TRAVELS from the site of formation and clogs an artery
Types of Stroke
2. Hemorrhagic strokes
o Weakened arterial walls burst under pressure in
case of an aneurysm or arteriovenous malformation.
o Aneurysm:
▪ Saclike bulge on the wall of a weakened artery
o The rupture of an aneurysm or malformed arterial
wall causes cerebral hemorrhage
Risk for Stroke
Risk is increased in individuals with:
● History of alcohol use
● History of smoking
● Poor diet
● Lack of exercise
● High blood pressure
● High cholesterol
● Diabetes
● Obesity
● TIAs
https://www.youtube.com/watch?v=uArDX7EN34c&list=PL6Xl6PKloZnqXLs57SaSkQC8TIZxhjIxi&index=12
Deficits associated with Aphasia
● Location of brain damage contribute to the
type and severity of language deficits
● People with aphasia (PWA) can have deficits in:
o Expression
o Comprehension
o Written language
o Reading
● PWA may also demonstrate emotional deficits
such as lability, depression, frustration
 Deficits associated with Aphasia
● Other secondary deficits include,
o Physical/sensory deficits:
▪ Hemiplegia: paralysis on one side
▪ Hemiparesis: weakness on one side

o Cognitive deficits:
▪ Deficits in working memory, attention
▪ Neglect: does not recognize or pay attention to one side of the
body
▪ Disinhibition: inability to inhibit certain behaviors
Expressive Language Deficits
● Anomia
o Difficulty in naming
▪ Word-finding difficulty
▪ PWA may “talk around” the missing word
(circumlocution)
▪ PWA may perseverate or repeat an incorrect
word
Expressive Language Deficits
● Paraphasia
o Word substitution
▪ Phonemic paraphasia
● Substituted word sounds like the target word
● ex. cable for table
▪ Semantic paraphasia
● Substituted word has similar meaning or is associated
to target word
● ex. bench for chair
● Neologism
o Create new words that do not exist
▪ “floshan” for flossing
 Expressive Language Deficits
● Agrammatism
o Omission of grammatical elements resulting in
telegraphic speech
▪ “Me go store”
● Jargon
o Fluent but meaningless speech
o May contain neologisms
▪ “I went for a grass on the house.”
● Stereotypic expressions (Verbal stereotype)
o Routine use of certain expressions
▪ “I know, I know”
Other Expressive Language Deficits
● Agraphia (writingdeficits)
o Difficulty making letters/words
o Agrammatism, jargon, and neologisms may
be present

● Alexia (reading deficits)

o Difficulty recognizing printed words
Comprehension Deficits
● Comprehension Deficits
o Difficulty understanding others
o Difficulty understanding complex sentences
o Difficulty following multi-step commands
Types of Aphasia
1. Global aphasia http://www.youtube.com/watch?v=6CJWo5TDHLE

Lesion location Large area of the left hemisphere

Type Non-fluent
Primary feature severe deficits in auditory
comprehension and verbal expression
Auditory comprehension very poor
Reading comprehension poor
Expressive language limited to few spontaneous stereotypic
productions; poor repetition; poor naming
Accompanying deficits motor deficits, apraxia, paresis/paralysis
Types of Aphasia
2. Broca’s Aphasia http://www.youtube.com/watch?v=f2IiMEbMnPM

Lesion location Broca’s area

Type Non-fluent
Primary feature impaired expressive language
Auditory comprehension relatively good, deficits with syntactically
complex sentences
Reading comprehension variable
Expressive language short, agrammatical sentences; slow
labored speech with articulation and
phonological errors; poor repetition and
poor naming
Accompanying deficits motor deficits, apraxia, paresis/paralysis
Types of Aphasia
3. Wernicke’s aphasia http://www.youtube.com/watch?v=aVhYN7NTIKU

Lesion location Wernicke’s area

Type fluent
Primary feature disturbed auditory comprehension
Auditory comprehension poor
Reading comprehension impaired
Expressive language semantic paraphasias; jargon; poor
repetition; impaired naming. Sentences are
usually grammatical, but often lack content
Accompanying deficits sensory deficits, agnosia
Types of Treatment
● Restorative Therapy:
o Remediate language deficits
▪ ex. Melodic intonational therapy, Constraint-induced
language therapy http://www.youtube.com/watch?v=tiJ9X_wLSWM (2:27)
http://www.youtube.com/watch?v=rwDVsoDQfJQ

● Compensatory Therapy:
o Strategies exploit strengths of the individual in
order to minimize/compensate for deficits
o SLP helps client and family focus on functional
communication solutions
▪ ex. using a communicative partner, communication boards
http://www.youtube.com/watch?v=tUIr8_QJZ30
Recovery from Aphasia
The Recovery Process
1. Spontaneous recovery:
▪ Natural restorative process
▪ Begins within hours or days of the stroke
▪ Continues for up to about six months after
stroke
▪ Significant recovery may occur; disorder may
change quite drastically
▪ Partially due to reduction of swelling in brain,
reorganization of functions in the brain
 Recovery from Aphasia
The Recovery Process
2. Rehabilitation:
▪ Rehabilitation team: SLP, PT, OT, and others

SLP is part of a team often including physician,

neurologist, physical therapist, occupational
therapist, dietician, nursing
 Recovery from Aphasia
● Factors that influence prognosis
o Age
o General health
o Handedness
o Family support
o Recency of neurological event

● Treatment settings: Acute care hospital →

Rehabilitation center/home → Outpatient
services/home-health services
TRAUMATIC BRAIN INJURY (TBI)
TBI
● Disruption in the normal functioning of the
brain caused by a blow to the head or a
penetrating head injury.
TBI
● Prevalence
o 1.4 million cases of TBI/year in U.S.
▪ 50,000 die
▪ 235,000 require long hospitalization
o ~5.3 million Americans currently have long-
term need for help in performing daily
activities
● Male:Female = 2:1
o Highest frequency: males 15-25
TBI
● Causes
o Majority of cases due to falls (28%)
▪ young children and elderly individuals
o Motor vehicle accidents (20%)
o Other causes
▪ Sports-related accidents
▪ Assaults
Neurology of TBI
● TBI results in non-focal injury
o Brain damage is diffuse (widespread)
● Damage is due to the rapid acceleration
and forceful impact of the brain against
the skull
o Coup injury: injury at the site of impact
o Contrecoup injury: injury on the side
opposite to the impact
http://www.traumaticbraininjuryatoz.org/Mild-TBI/Coup-Contrecou
p
Deficits from TBI
● Impairments resulting from TBI
o Physical
▪ Paralysis, paresis
o Cognitive
▪ Errors in judgement, deficits in attention and
memory, impulsivity
o Communicative
▪ Pragmatic: poor turn-taking, topic maintenance,
inappropriate emotional language
▪ Problem solving, reasoning
o Behavioral and Emotional
▪ Disinhibition, impulsivity, aggressiveness
Speech and Language Deficits
● Speech
o ~33% have dysarthria
● Language
o Language deficits reflect impaired underlying
processes: information-processing, problem-
solving, reasoning
o Anomia and impaired comprehension most common
o Impaired pragmatics
▪ Disinhibition: inability to stop certain inappropriate
behaviors
▪ Poor affective/emotional language abilities
● Voice and Swallowing
Behavioral and Emotional Deficits
● Mood swings
● Anxiety
● Depression
● Lack of motivation
● Inability to self-monitor (denial)
● Impulsivity
● Difficulty with emotional control and anger
management
http://www.youtube.com/watch?v=dyqGys9Htbo
Intervention
Goals based on stage of recovery
● Early Stage
o Beginning responses to environment in hospital –
stabilization is the overriding goal
● Middle Stage
o Goal: to reduce confusion and improve memory
and goal-directed behavior
● Late Stage
o Goal: client independence
Cognitive Rehabilitation
● Treatment regimen designed to increase.
Functional abilities for everyday life by
improving the capacity to process incoming
information
o Restorative Approach:
▪ Repetitive activities to rebuild neural circuitry
▪ ex., classification tasks, word associations,
rehearsal, memory aids
o Compensatory Approach:
▪ Develop alternatives, since some function will not
be recovered
APT Tasks
APT: Attention Process training Program
Goes through five levels of attention

• Sustained attention: Basic level. Listening for one thing

• Complex sustained attention: more complex
things you’re paying attention to
• Selective attention: how well can you select what
you’re paying attention to with other distractions
• Divided attention: multitasking
• Alternating attention: switching from one thing to the
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