Aphasia Assessment And Intervention

Front 1

3 Stages of Spontaneous Recovery

Back 1

Acute (onset to Day 3)
Subacute (3-21 days post stroke)
Chronic (anything past 30 days)

Front 2

Purposes of Assessment

Back 2

1. To identify specific problems (is there an aphasia?)
2. To describe language behaviors
3. To determine intervention goals
4. To identify factors that facilitate the retrieval of language

Front 3

Assessment Outlines (parts of an assessment)

Back 3

1. Patient History
2. Speech and Language testing
3. Informal Observation
4. Additional testing (cognition, hearing, swallowing, motor speech)

Front 4

Patient History (what to include)

Back 4

1. Medical Chart/Case History form
2. Personal history
3. Medical History
4. Identify dx
5. Medical Orders (for hospital or if insurance requests)

Front 5

What is the nature of impaired auditory comprehension?

Back 5

-Difficulty applying meaning to incoming words
-Difficulty understanding word relationships
-May be be confounded by a memory impairment

Front 6

Auditory Comprehension Assessment Tasks

Back 6

-Single word comprehension
-Comprehend objects by function
-Follow 1,2,3, step directions
-Comprehend simple yes/no ?s
-Comprehend complex yes/no ?s
-Comprehend simple and complex Wh- ?s
-Comprehend narratives of increasing length
-Understand simple conversation with others

Front 7

Memory deficits that can be associated with impaired auditory comprehension

Back 7

-Slow rise time
-Noise build up
-Retention deficit
-Information capacity deficit

Front 8

Comprehension is inversely proportional to...

Back 8

the level of abstractness, intellectual complexity, semantic relatedness, rate of presentation, sometimes length

Front 9

Conditions that facilitate auditory comprehension

Back 9

-word frequency of occurrence
-word class
-imageability
-salience
-presence of context
-repetition
-personal interest
-number of answer choices

Front 10

With how many answer choices does performance decrease?

Back 10

7-8 unrelated pictures
or
3-4 related pictures

Front 11

Nonlinguistic factors that facilitate comprehension

Back 11

-decreasing rate of speech; pauses
-repetition and redundancy
-gestures and visual stimuli

Front 12

What is the nature of impaired verbal expression?

Back 12

-Deficiencies in word finding including some paraphasic errors
-Syntactic impairment
-Motor speech production impairment (apraxia or dysarthria)

Front 13

Marshall's Hierarchy

Back 13

Delay (LEAST IMPAIRED)
Semantic Association
Phonetic Association
Description
Generalization (MOST IMPAIRED)

Front 14

What is the nature of impaired reading comprehension?

Back 14

-Process is slowed and more effortful
-Difficulty understanding syntax
-Difficulty understanding words
-Visual problems (hemionopsia)
-May be associated with memory deficit (can't be sure if it is a decoding problem or a memory problem)

Front 15

Assessment tasks for impaired reading comprehension

Back 15

-Match letters, words
-Match words to pictures
-Recognizing and reading letters
-Read/comprehend sentences of increasing length, then syntax
-Comprehend main point of, then detail question of, paragraphs of increasing length
-Comprehension of daily life materials (menu, bible, etc.)

Front 16

Description of nature of writing disturbances

Back 16

-Paresis or nondominant hand use; mechanical errors
-Literal, verbal neologistic paraphasias in writing only
-Complete agraphia

Front 17

Assessment tasks for written expression disturbances

Back 17

-Copying letters/words
-Writing to dictation letters/words
-Automatic writing tasks (name, address, numbers)
-Writing 1 word/short phrase answers to questions
-Writing a picture/object description

Front 18

Broca's Aphasia

Back 18

-Nonfluent; agrammatic, telegraphic, abnormal prosody, decreased length, word-finding problems
-May have apraxia
-Mild-Severe naming/repetition
-Good comprehension
-Good reading
-Writing difficulties b/c hemiplegic/telegraphic/agrammatic; decreased output

Front 19

Wernicke's Aphasia

Back 19

-Fluent; grammatical, but no content; paraphasia; logorrhea
-Good articulation
-Mild-Severe naming and repetition
-Poor comprehension and reading
-Writing reflects speech output

Front 20

Conduction

Back 20

-Fluent with paraphasic errors
-Good articulation generally
-Mild-Severe naming impairment
-EXTREMELY POOR REPETITION
-Mild/Mod comprehension, trouble with complex or mult. speakers
-Reading usually good
-Writing reflects speech

Front 21

Anomic

Back 21

-Fluent with WORD FINDING PROBLEMS
-Good articulation
-SPECIFIC DIFFICULTY with NAMING
-mild/mod repetition and comprehension
-reading and writing are good

Front 22

TCM

Back 22

-Less severe than Broca's; speech can be fluent/sparse
-May have apraxia
-Naming better than expected
-CAN REPEAT
-good comprehension, reading, writing

Front 23

TCS

Back 23

-Similar to Wernicke's but more paraphasias; lacks nouns; no logorrhea
-Mod/Sev naming
-CAN REPEAT
-Poor comprehension
-Good reading and writing

Front 24

Global

Back 24

-Nonfluent, few words, serial utterances, stereotypic phrases, uncommon expletives
-Severely impaired naming, repetition, comprehension, reading, and writing

Front 25

How do you facilitate expression?

Back 25

-Recall what we know about what words/structures to select.
-Discuss activities participated in before the stroke
-Find out nature of the activities/what % of time was devoted to each
-Ask if the person can still do this things: life now vs. before the stroke
-Counsel about adjusting to life now (what makes a person competent and good?)

Front 26

How do we use Marshall's Hierarchy to judge expression?

Back 26

Judges a patient's errors form least to most impaired.

Front 27

How do we use Marshall's Hierarchy as a cueing system?

Back 27

Delay: give least amount of info, but give pt time to think
Semantic: give 2 words semantically related to target
Phonetic: "It starts with /b/"
Description: describe the target
Generalization: SLP says the target word and patient repeats

Front 28

What is the most salient cueing association?

Back 28

Semantic cues and initial sound of the word

Front 29

What does CART stand for?

Back 29

Copy And Recall Treatment

Front 30

What are the steps for CART?

Back 30

1. ACT (Anagram, Copy Treatment): Pt writes down word given a picture; if can't do it, SLP tells pt the word; if still can't do it; SLP gives the letters in any order
2. CART homework: if successful in therapy
3. Conversation: ask questions to elicit target words (use functional words)

Front 31

What is VCIU?

Back 31

Voluntary Control of Involuntary Utterances

Front 32

What are the steps for VCIU

Back 32

1. Create a list of real words that anyone has heard the pt say spontaneously.
2. Write words on notecards.
3. Show pictures of targets and ask pt to say; if can't, show written word and ask to read; Only keep words pt can name
4. ask questions requiring target words to answer with picture cue and eventually without picture cue. Can use cloze.

Front 33

What does RET stand for?

Back 33

Response Elaboration Training

Front 34

Who would you use RET with?

Back 34

Patients with some verbal expressive abilities (higher level than CART and VCIU). Can be nonfluent or fluent. Works for apraxia.

Front 35

What are the steps for RET?

Back 35

1.Verbal instruction and stimulus presentation.
2. Elaboration, model, reinforce
3. Cue with a wh- question
4. Combine pt response, model, reinforce
5. Request repetition and model
6. Reinforce, model

Front 36

What is the goal of RET?

Back 36

To activate the semantic network.

Front 37

What is the hypothesis behind semantic feature analysis?

Back 37

Impaired access or slowed processing to get to the lexicon. If we directly work on the semantic system, it should improve their comprehension and expression.

Front 38

How does semantic feature analysis work?

Back 38

Patient comes up with words and SLP comes up with semantically-related features.
-What does it look like?
-How do you use it?
-When do you use it?
-Who uses it?
-Why do you use it?