1. Adult Aphasia and Other Cognitive-Based Dysfunctions
Justice Communication Sciences and Disorders: An Introduction
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2. 8.2
Introduction
Language and cognitive disorders associated with acquired neurological injury:
Aphasia: difficulties in expressing, understanding, reading, or writing oral and written language
Right Hemisphere Damage: memory impairment, attention and impulsivity problems, and visual dysfunction
Traumatic Brain Injury: cognitive impairment caused by brain damage from injury
Dementia: loss of linguistic and cognitive ability due to a progressive brain disease
4 basic types- aphasia, right hemisphere damage, traumatic brain injury and dementia.
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

3. I. What is Aphasia? Literally means “without language” Definition:
8.9
I. What is Aphasia?
Literally means “without language”
Definition:
A disturbance in the adult language system after the language has been established or learned
Results from neurological injury to the language-dominant hemisphere of the brain
Includes disturbances of receptive and/or expressive abilities for both spoken and/or written language
Always post trauma! Stokes, heart attacks…any aspect of launguage can be affected.
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

4. Aphasia examples http://www.youtube.com/watch?v=Bk13HLma2C I
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Aphasia examples

5. Additional Considerations
8.10
Additional Considerations
Aphasia is not developmental, it is acquired following a neurological injury
A person with aphasia usually has intact psychosocial skills;
Must be careful not to confuse language deficits of an individual with aphasia for a more general psychological disturbance
Aphasia is a language-based dysfunction, not a motor-based dysfunction, although the two sometimes coexist (dysarthria + aphasia)
Aphasia is not developmental its acquired. Dysarthria is moter oral weekness.
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

6. II. How is Aphasia Classified?
8.11
II. How is Aphasia Classified?
Aphasia types should be grouped or classified (taxonomy), but some debate over how to do this
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Categorization by cause and location of the brain damage
Categorization based on the language characteristics
-fluent vs. non-fluent speech
-receptive vs. expressive deficits
-motor vs. sensory deficits
Fluent aphasia – can speak clearly but have very random speech.
Justice Communication Sciences and Disorders: An Introduction
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7. 8.12
Most professionals classify aphasia types based on distinct behaviors:
Fluency of expression
Language comprehension
Naming
Repetition
Additional considerations:
Motor output: Are the motor systems involved with speech affected? This indicates a coexisting motor- speech disorder
Reading and writing: To what extent is reading and writing affected? This usually reflects the overall impact of aphasia on language more generally
Behavioral Symptoms
Justice Communication Sciences and Disorders: An Introduction
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8. 8.13
Fluency
Expression of thoughts using a smooth, uninterrupted flow and rate of speech
Fluent aphasia: spontaneous speech flow with adequate phrase length
Generally reveals posterior brain damage (temporal/parietal regions)
Non-fluent aphasia: diminished phrase length, slowed or labored speech production, grammatical errors
Generally reveals anterior brain damage (frontal lobe)
Justice Communication Sciences and Disorders: An Introduction
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9. Language Comprehension
8.14
Language Comprehension
Ability to understand spoken messages
Influenced by:
Amount of information
Frequency of word usage
Personal relevance of information
Part of speech
Based on this ability, aphasia can be classified as predominantly receptive or predominantly expressive
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

10. Repetition Ability to accurately reproduce verbal stimuli
8.15
Repetition
Ability to accurately reproduce verbal stimuli
In order to display this ability, one must:
Receive and process incoming stimulus
Convey the information to regions of brain that formulate and plan motor sequence for speech
Articulate to reproduce the initial stimulus
Repetition skills can subcategorize a more general classification
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

11. Naming Ability to retrieve and produce a targeted word
8.16
Naming
Ability to retrieve and produce a targeted word
Anomia: disturbance in the ability to name
Most pervasive and most persistent deficit (good test question)
Paraphasias (patterns of speech errors):
Phonemic: substitution or transposition of the targeted phoneme (non-fluent, expressive, motor aphasia group)
Semantic: error is related or in the same category but is incorrect (fluent, receptive, sensory aphasia group)
Can recognize visually what the object is but can’t think of the name (anomia)
Justice Communication Sciences and Disorders: An Introduction
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12. 8.17
Reading and Writing
Written language disturbances usually parallel spoken language impairments
Non-fluent speakers will also be non-fluent in writing and reading
Individuals with auditory comprehension problems also have problems comprehending written information
This is not a rule but its true most of the time.
Justice Communication Sciences and Disorders: An Introduction
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13. 8.18
Aphasia Syndromes
More refined labeling of the aphasias facilitates communication across professional disciplines
Described based on the defining, salient characteristics
Aphasia syndromes include:
-Broca’s -transcortical motor
-global -Wernicke’s
-conduction -transcortical sensory
-anomic
Know about the broca and the wernicke’s anatomy for the test.
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

14. Broca’s Aphasia http://www.youtube.com/watch?v=RCVRGEhT0wo&NR=1
8.19
Broca’s Aphasia
Location of damage: frontal lobe, specifically Broca’s area
Non-fluent, expressive, motor
Slowed, labored, telegraphic speech; short phrases, agrammatical speech
Expressive problems are hallmark of this type, but also receptive deficits
Repetition and naming difficulties range from mild to severe
Reading is slowed and laborious, writing is effortful and oversized (macrographia)
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Justice Communication Sciences and Disorders: An Introduction
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15. Transcortical Motor Aphasia
8.20
Transcortical Motor Aphasia
Location of damage: frontal lobe, typically superior and anterior portions
Non-fluent, expressive, motor
Characteristics are the same as Broca’s aphasia except these clients show far better repetition skills
Also show strong performance in oral reading
Are able to repeat words that are spoken by someone else unlike borca aphasia-people cannot repeat words that are spoken
Justice Communication Sciences and Disorders: An Introduction
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16. 8.21
Global Aphasia
Location of damage: large region of brain or multiple sites of injury
Non-fluent, both receptive and expressive, and both motor and sensory
Severe problems communicating
Often non-verbal with limited gestures
Reading and writing deficits
Justice Communication Sciences and Disorders: An Introduction
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17. 8.22
Wernicke’s Aphasia
Location of damage: temporal lobe, possible parietal also, specifically Wernicke’s area
Fluent, receptive, sensory
Spontaneous speech with normal prosody, sometimes even logorrhea, but meaningful content is limited
Semantic paraphasias, neologisms, jargon
Poor auditory comprehension, repetition, and naming (use circumlocution), writing is fluent but message is unclear (like verbal)
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Logorrhea – exageration Circumlocution- talk around the word.
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

18. Transcortical Sensory Aphasia
8.23
Transcortical Sensory Aphasia
Location of damage: border of the temporal and occipital lobes or the parietal lobe (superior region)
Fluent, receptive, sensory
Characteristics are the same as Wernicke’s aphasia except these clients show far better repetition skills
Sometimes even frequent verbal repetitions of random auditory stimuli (echolalia)
Similar to wernicies aphasia.
Justice Communication Sciences and Disorders: An Introduction
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19. 8.24
Conduction Aphasia
Location of damage: temporal-parietal region, usually a connector pathway called arcuate fasciculus
Fluent, mild deficits in expression or reception
Inabilities to repeat verbal stimuli or read aloud – receive and process stimuli but cannot transfer this to the verbal output area
Reception is good…but dificulting repeating things.
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

20. More on Conduction Aphasia
Patients with conduction aphasia show the following characteristics:
speech is fluent
comprehension remains good
oral reading is poor
Major Impairment in repetition
many phonemic paraphasias (phone substitution errors)
transpositions of sounds within a word ("television" → "velitision") are common
(this info from Wikepedia)
If you can pair an emotion with a memory it will be easier to remember.
More on Conduction Aphasia

21. Anomic Aphasia Location of damage: no specific area
8.25
Anomic Aphasia
Location of damage: no specific area
Fluent and meaningful
Word retrieval deficits in both spoken and written language
Most pervasive and most common aphasia profile
Start for thursday
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

22. Aphasia - Causes Results from neurological damage or brain injury
8.26
Aphasia - Causes
Results from neurological damage or brain injury
Stroke: most common cause – blood supply providing nutrients and oxygen to the brain is interrupted (when language area of the brain is affected, aphasia can happen)
utube.com/watch?v=F16q32hA31c
Infectious diseases
Tumors
Exposure to toxins or poisons
Hydrocephalus
Nutritional or metabolic disorders
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

23. Aphasia Prevalence and Incidence
8.27
Aphasia Prevalence and Incidence
National Stroke Association:
Stroke occurs every 45 seconds in the U.S.
750,000 people each year
Total number of surviving stroke victims in the United States: 4 million
Health care costs in this country for stroke:
$30 billion annually
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

24. Aphasia – Risk Factors Uncontrollable factors Controllable factors Age
8.28
Aphasia – Risk Factors
Uncontrollable factors
Age
Gender
Racial or ethnic background
Family history
Controllable factors
Hypertension
Diabetes
Tobacco smoking
Alcohol use
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

25. III. How is Aphasia Identified?
8.29
III. How is Aphasia Identified?
Assessment of speech and language disturbances – important component
Assessment and treatment completed by interdisciplinary team of professionals using a holistic approach
Evaluation goals will address:
Presence or absence of aphasia
Type or syndrome of aphasia
Most beneficial treatment plan
Prognosis for recovery
Referrals to other professional as needed
How do I distinguish between aphasia or some other disorder? Support from family is most important thing to getting better….then motivation.
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

26. 8.30
Assessment of Aphasia
Initial informal clinical assessment (survey of speech and language performance in about 30 minutes):
Aphasia Language Performance Scales (ALPS)
Bedside Evaluation Screening Test (BEST)
Extensive, comprehensive assessment (after client becomes more medically stable):
Choice of Aphasia battery influenced by clinician preference, test availability and unique client needs
Assessment should be ongoing and comprehensive
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

27. IV. How is Aphasia Treated?
8.31
IV. How is Aphasia Treated?
Prognostic Indicators
Factors that predict or determine which clients will benefit from therapy
Include:
Site, type, and size of brain injury
Time post onset (TPO)
Type and severity of aphasia
Handedness
Age
Pre-injury status
Very similar to treatments used on children with phonological disorders.
TPO – how long after injury are we getting this patient.
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

28. Treatment strategies: the client’s compensatory strategies
8.32
Designing Treatment Plans
Treatment strategies: the client’s compensatory strategies
Self-directed
Clinician-directed
Treatment approaches: target the specific deficits and the underlying processes that produce the errors
When designing treatment plan, consider evidence-based practice (interventions that have been studied and proven effective in a controlled setting for a particular disorder)
Self-directed- lets the patient choose their path of treatment.
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

29. Determining the Setting
8.33
Determining the Setting
Multiple environments should be used for treatment to facilitate carryover of improvements
Co-treatments with occupational therapist
Community reentry programs
Group therapy (most beneficial for chronic aphasia) helps with socialization.
Tend to get more depression with aphasia.
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

30. Outcomes: functional communication improvements with intervention
8.34
Measuring Outcomes
Carryover of test scores to real-world communication is the standard for effectiveness of treatment
Outcomes: functional communication improvements with intervention
Instruments to measure outcomes:
Communication Abilities of Daily Living, Second Edition (CADL-2)
Functional Independence Measures (FIMS)
ASHA Functional Assessment of Communication Skills (ASHA-FACS)
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

31. V. Cognitive-Based Dysfunctions
8.35
V. Cognitive-Based Dysfunctions
Right Hemisphere Dysfunction
Traumatic Brain Injury
Dementia
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

32. What is Right Hemisphere Dysfunction (RHD)?
8.36
What is Right Hemisphere Dysfunction (RHD)?
Neurological damage to the right cerebral hemisphere
Communication profile is different than aphasias (left hemisphere is usually language hemisphere)
Cognitive, perceptual or behavioral disruptions are most prevalent, but still language difficulties
Cognitive-linguistic disorder
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Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

33. LEFT BRAIN FUNCTIONS uses logic detail oriented facts rule words and language present and past math and science can comprehend knowing acknowledges order/pattern perception knows object name reality based forms strategies practical safe
RIGHT BRAIN FUNCTIONS uses feeling "big picture" oriented imagination rules symbols and images present and future philosophy & religion can "get it" (i.e. meaning) believes appreciates spatial perception knows object function fantasy based presents possibilities impetuous risk taking

34. Defining Characteristics of RHD
8.37
Defining Characteristics of RHD
Lack of insight to deficits
Lack of attention or complete neglect of the left side of the body
Difficulty recognizing faces
Compromised pragmatics
Problems understanding and/or using higher-level cognitive-linguistic skills
Neuromotor compromise, resulting in dysarthria or dysphagia
Justice Communication Sciences and Disorders: An Introduction
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35. 8.38
How is RHD Identified?
Comprehensive speech-language assessment by interdisciplinary team
Additionally, further assessment of:
Higher-level language skills
Visual-perceptual performance
Pragmatic appropriateness
Available standardized batteries:
Mini Inventory of Right Brain Injury (MIRBI)
Right Hemisphere Language Battery (RHLB)
Clinical Management of Right Hemisphere Dysfunction-Revised (RICE-R)
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

36. How is RHD Treated? Initial therapy: Further treatment:
8.39
How is RHD Treated?
Initial therapy:
Management of attention and visual disruptions
Further treatment:
Higher-level cognitive-linguistic tasks
Activities for explain abstract thoughts or making inferences
Pragmatics of communication interactions
Both individual and group treatment
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

37. What is Traumatic Brain Injury?
8.40
What is Traumatic Brain Injury?
Neurological damage resulting from external forces impacting upon the brain
TBI occurs mostly from motor vehicle accidents, falls, and acts of violence
Leading cause of death and disability in U.S.
Males twice as likely to suffer from TBI
Lower SES backgrounds more likely
Infants, adolescents, and senior citizens more likely
4t-E
Good test question slide. Watch video link good insite on tbi.
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

38. Defining Characteristics of TBI
8.41
Defining Characteristics of TBI
Open-head injuries: skull and brain have been penetrated – focal injuries(gunshot wond to head)
Closed-head injuries: no penetration of skull or brain, but brain jostled – diffuse injuries
Diverse group: cognitive impairments are a result of the size, location, and overall severity of the injury
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

39. How are Cognitive-Linguistic Deficits of TBI Identified?
8.42
How are Cognitive-Linguistic Deficits of TBI Identified?
Early phases of TBI:
Glascow Coma Scale: observes eye opening, motor behavior, and verbal responses
Rancho Los Amigos Levels of Cognitive Function: eight levels of cognitive functioning
Later phases (after client improves medically) – more extensive testing:
Brief Test of Head Injury
Scales of Cognitive Ability for TBI
Ross Information Processing Assessment – 2nd Edition
Cognitive linguistic quick test- good short test to test overall cognative function.
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

40. How are Cognitive-Linguistic Deficits of TBI Treated?
8.43
How are Cognitive-Linguistic Deficits of TBI Treated?
Early stages – Rancho Levels I-III:
Stimulation treatment: activities to facilitate arousal, altering, and attention
Middle stages – Rancho Levels IV-VI:
Tasks to establish basic communication systems
Later stages – Rancho Levels VII-VIII:
Focus on facilitating independence
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

41. 8.44
What is Dementia?
Chronic and progressive decline in memory, cognition, language, and personality resulting from CNS dysfunction
Alzheimer’s disease is the most common disorder producing dementia
Dementia is the most prevalent in the older population
DSM-IV Criteria:
Memory impairment
Cognitive skills deficits
Either aphasia, apraxia, or agnosia
Must have a gradual onset and progressive functional decline
Gradual beginning then declining.
Alzheimers plato then drop…its not a steady decline.
Justice Communication Sciences and Disorders: An Introduction
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42. Characteristics of Mild Dementia
8.45
Characteristics of Mild Dementia
Forgetfulness, even of basic information and common routines
Decreased vocabulary choices
Reduced or verbose conversation
Anomia – word finding.
Pragmatics and motor function are still intact
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Justice Communication Sciences and Disorders: An Introduction
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43. Characteristics of Moderate Dementia
8.46
Characteristics of Moderate Dementia
Disoriented to time and place
Poor attention and memory
Marked language difficulties (anomia, repetition problems, “empty” conversation, difficulty understanding humor)
Restlessness and roaming may occur
Justice Communication Sciences and Disorders: An Introduction
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44. Characteristics of Severe Dementia
8.47
Characteristics of Severe Dementia
Disorientation
Minimal cognitive ability
Very poor language and comprehension skills
Motor skills vary, but many are confined to a wheelchair and unable to control bowel and bladder functions
Justice Communication Sciences and Disorders: An Introduction
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45. How is Dementia Identified?
8.48
Screening of mental status:
Mini Mental State Examination
Mental Status Subtest of the Arizona Battery for Communication Disorders of Dementia
Comprehensive testing:
Arizona Battery for Communication Disorders of Dementia (ABCD): tests linguistic comprehension, linguistic expression, verbal memory, visuospatial skills, and mental status
How is Dementia Identified?
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.

46. How is Dementia Treated?
8.49
How is Dementia Treated?
Mild to moderate cases:
Activities to compensate for deficits
Environmental changes to promote safety
Education for family members
Active support groups for caregivers
Severe cases:
Resources necessary are probably beyond capabilities of the family
Long term placement in a nursing home or supported group environment is necessary
Justice Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved.